Hip and Knee Replacement—Getting Closer to "One and Done"

with Bruce T. Fauré, M.D., Orthopaedic Surgery and Joint Reconstruction, Advanced Healthcare

Last Updated: Nov. 1, 2003

How long will your hip or knee replacement last? The latest artificial joints could remain functional much longer than those of just a couple of decades ago, explained Dr. Bruce Fauré, a joint replacement specialist with Advanced Healthcare.

Most of the credit goes to improved materials, but that’s only part of the story. Recent advances coupled with promising new ideas are helping doctors get closer to the goal of performing joint replacements that last a lifetime.

Bruce T. Fauré, M.D., Orthopaedic Surgery and Joint Reconstruction, Advanced Healthcare "Doctors are closing in on the goal of the 'one and done' operation - the joint replacement that lasts a lifetime."

Minimally invasive techniques reduce pain, speed recovery
Over the past several years, minimally invasive surgery has had a big impact on American health care, including joint replacement procedures. “It’s the same operation,” Dr. Fauré clarified, “just using a smaller incision.”

Joint replacement incisions on the whole, he said, have shrunk by half over the last five years. With a smaller incision at surgery, patients experience less pain during recovery. In addition, blood loss is reduced.

The bottom line is reduced pain and shorter recovery. These benefits of minimally invasive surgery have helped make joint replacement more of a “routine” procedure.

Dr. Fauré cautions that “minimally invasive” means different things for different people. Most very heavy or very muscular patients require a larger incision to provide the necessary visibility of the joint during surgery.

Improved materials more like real thing
For both hip and knee replacement, the biggest challenge of recent years has been engineering a durable joint bearing – the cartilage replacement that has to stand up to ongoing pressure and abrasion and still allow for smooth movement. Without an extremely tough and low-friction material, the joint replacement can wear out before the patient does.

According to Dr. Fauré, most artificial knees placed in patients in the 1980s lasted 10 to 15 years. Hip replacements from the same era held up about 15 to 20 years. Now, thanks to bearings made from improved materials, replacement joints are functioning more naturally – and promise to last much longer.

Of course, we do not yet have any patient trial results, but lab tests suggest that improved plastics now going into joint bearings are 20 times more durable than the materials used a few years ago. Even more impressive, bearings made of some highly improved ceramics and metals could be as much as 100 to 200 times more durable.

If these test results pan out in real world use, the problem of the lifetime joint replacement could be nearly solved. The last frontier will be perfecting the surgical procedure itself.

"Navigation" systems point to the future
According to Dr. Fauré, experts estimate that 25% of Americans will some time in their life experience arthritis severe enough to require a joint replacement. In the United States, he said, 200,000 knee replacements and 250,000 hip replacements are performed every year.

Currently, surgeons rely on visual estimation to properly position joint replacement components during surgery. This estimation is based on years of training and clinical experience, but as Dr. Fauré said, it is still “eyeballing it.”

What if you could use navigation technology to place joint components with perfect accuracy? Doctors worldwide are now experimenting with this concept in different ways. The idea is simple: The physician attaches tracking “markers” to the joint bones at the beginning of surgery. Corresponding markers are built into the joint replacement components. When the navigation technology indicates optimal alignment, the surgeon fixes the components in place.
This technique is not yet practical, said Dr. Fauré – attaching the markers adds more time to the procedure. Still, this new idea presents some exciting possibilities:

First, if navigation technology could “replace” the surgeon’s eyes, surgical incisions could be even smaller and minimally invasive joint replacement would be possible for more patients. One could even imagine joint replacement surgery performed robotically by a physician who navigates equipment via a computer monitor.

Second, if joint reconstruction specialists could achieve 100% correct placement, 100% of the time, process inconsistency would be drastically reduced. Dr. Fauré pointed out that the knee, for example, is an extremely complex structure, one that presents many opportunities for missteps in surgery. Navigation technology could help ensure every joint replacement is perfectly executed.

That, said Dr. Fauré, would get us closer to the day when the “one and done” joint replacement is a reality.

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